Violence Against Healthcare Personnel: Legal Regulations and Erroneous Practices

In this study, two topics have been addressed:

1) What legal regulations have been made with the increase of violence?

2) What is the impact of erroneous practices?

In other words, our article will cover the laws that have been accepted and enacted in the Turkish Grand National Assembly (TBMM) regarding the increase of such actions, as well as the administrative measures introduced by governments as additional precautions. Additionally, partial errors that can have a negative impact on investigations conducted due to these actions have been exemplified.

We can summarize the list of legislation in this regard as follows:

1- Laws:

- Article 54 of the Decree Law No. 663 dated 02.11.2011,

- Article 12 of the Basic Health Services Law No. 3359 (Article 47 of Law No. 6514 dated 02/01/2014): Additions were made with Article 21 of Law No. 7151 dated 15/11/2018 and with Article 28 of Law No. 7243 dated 15/04/2020.

- Article 18 of the Basic Health Services Law No. 3359 (introduced by Article 14 of Law No. 7406 dated 12/5/2022).

- Article 100/3-j of the Criminal Procedure Code No. 5271 (amended by Article 9 of Law No. 7406 dated 12/5/2022).

2- Regulations:

- Regulation on the Procedures and Principles of Legal Assistance to be Provided for Crimes Committed Against Health Ministry Personnel,

- Regulation on Ensuring Patient and Employee Safety in the Ministry of Health.

3- Circulars:

- Circulars of the Ministry of Health dated 14/05/2012 and numbered 2012/23, and dated 27/07/2012 and numbered 2012/850,

- Circular of the Ministry of Interior dated 26/04/2012 and numbered 2012/22.

In summary, according to the legislation listed above, the following can be stated:

1. The White Code Unit of the Ministry of Health has been established: This unit provides 24-hour service. It monitors acts of violence that occur against its members and constitute a crime. It can be reached at the phone number 113 or via the website www.beyazkod.saglik.gov.tr. An incident reported here is assigned a white code number.

2. A legal assistance application has been introduced for personnel: In the event that a crime is committed against health workers serving in the Ministry and its affiliated institutions due to the provision of health services or their duties, legal assistance (appointment of a lawyer) will be provided free of charge upon the request of the relevant personnel during investigations or prosecutions. For this, without a power of attorney, the relevant legal advisors and lawyers represent the personnel in their capacity as proxies. This legal assistance can be in the context of criminal law, that is, in investigations or prosecutions. In compensation lawsuits, the general provisions regarding personal power of attorney relationships apply. Since the health units of universities have legal entities and legal departments, they are excluded from this.

3. Personnel working in private health institutions are considered public officials as of 02/01/2014 regarding crimes committed against them in connection with their duties (for which they are victims) under the Turkish Penal Code (TCK). In this regard, there is no longer a requirement for a complaint for individuals working in the private sector. The law amendment has only granted them the status of public officials in their favor. In other words, personnel working here are not granted the status of public officials regarding crimes they commit, that is, against them.

4. In investigations conducted due to intentional crimes committed against personnel working in health institutions and organizations due to their duties, the statements of health personnel who are complainants, victims, and witnesses will be taken at their workplaces (health institution) by police or gendarmerie officers as of 15/11/2018. If the personnel themselves wish, there is no obstacle for them to go to the relevant place to give a statement.

5. As of 02/01/2014, there may be grounds for arrest regarding the crime of intentional injury committed against personnel working in health institutions and organizations during or due to their duties. This is not applicable to all intentionally committed crimes but only to the crime of intentional injury. In other actions, general provisions and, if applicable, the conditions of the Criminal Procedure Code (CMK) can be evaluated regarding crimes that may be grounds for arrest. The amendment made to the special Law No. 3359 on 02/01/2014 was later removed on 12/5/2022 to be included in the CMK, which regulates the legal conditions for arrest, with the aim of further dissemination and increasing its effectiveness.

6. The penalties for intentional injury, threats, insults, and resisting the execution of duty committed against health personnel working in public or private health institutions and organizations will be increased by half as of 15/04/2020, and these penalties will not be deferred. Except for other threats, there is no requirement for a complaint when these crimes are committed against health personnel. Again, in the crimes of intentional injury and insult, while there is an aggravated circumstance for crimes committed against public officials, an additional aggravated circumstance has been introduced when committed against health workers. For example, the penalty for insulting a public official due to their duty is at least one year. If this crime is committed against a health worker, it is determined as 1 year and 6 months. Additionally, even if there are general legal conditions, the deferral of these penalties has also been closed off.

7. In the health unit where the violence occurred, if possible, as of 15/04/2020, health workers other than the victim will provide services to the perpetrator or their relatives. In other words, depending on the circumstances, the health worker who has been subjected to violence may not provide health services to the person who committed the violence.

8. The permission for investigation and the recourse of compensation have been regulated: A more specific regulation has been introduced for physicians and dentists working in public-private health institutions and foundations regarding investigations conducted due to the implementation of their health profession compared to public officials. Permission for investigation must be granted by the Professional Responsibility Board. Appeals against these decisions can only be made to the Ankara Regional Administrative Court. Also, whether the compensation paid by the administration due to professional practices will be recourse to the relevant party will be decided by this board within one year.

It is important to conduct faster and more effective investigations and to minimize errors in practice as much as possible. The fastest and most effective complaint method in the event of encountering a criminal act is to immediately notify the institution's security, along with reporting to the nearest police-gendarmerie unit or the relevant duty public prosecutor through the fastest means of communication for more accurate results.

Actions against health workers, except for exceptions, are not subject to direct investigation, in other words, a complaint is sufficient; only notification is required.

In fact, there is an obligation to notify. The decision to act or not is not at the discretion of the relevant authorities but is a legal obligation. The law enforcement must immediately inform the public prosecutor on duty about the notification made to them and must act in accordance with the instructions given.

Legal assistance has been provided to health professionals. However, this opportunity has been misinterpreted in a way that does not serve the purpose of an effective complaint method for wrongdoings or crimes, leading to situations where health workers sometimes prepare an incident report first and then send it to the public prosecutor's office through the provincial-district health directorate or the governorate-district governorate, depending on the situation. This method of complaint or notification is not an effective way. It often delays the investigation. The responsibility of the officials does not require that a notification has been made, but it can hinder the timely collection of evidence and the conduct of an effective and swift investigation. When complaints are made in the manner described above, it can make it difficult to achieve the desired results. However, it is possible to notify the relevant units and benefit from legal assistance after an effective and swift complaint has been made.

For example, during an examination, a patient's relative engaged in acts of insult-threat against the doctor. It is necessary to immediately notify the law enforcement, and if available, the hospital police, and then a complete report must be prepared by the officials present there. The incident report prepared first is very important in terms of evidence. It must be clear and understandable, answering questions such as who said what to whom, what was done, who saw or heard it, where the act took place, and who else was present besides the officials at that time. However, it often happens that these requirements are not significantly met, and obtaining any available institutional camera recordings is also necessary.

When documents arrive through the notification method mentioned above (in sequence), unreasonable periods can pass, which can cause difficulties in identifying the suspect and obtaining their defense. Moreover, if the incident report has not been prepared in a healthy content, it can become challenging to resolve the matter. This is because it is possible to encounter serious issues such as the relevant individuals sometimes leaving the province or their identities being unknown. Additionally, due to the passage of time, the inability to remember the incident, the workload, and frequently encountering similar incidents, victims or witnesses may struggle to remember the act and the suspects accurately. Such issues can often lead to results that favor the suspects in practice or allow them to benefit from the situation. Such a scenario or outcome can naturally lead to despair and distrust in the victim. The denial of the suspect, on the other hand, can cause serious legal issues regarding the collection of concrete and clear evidence in a timely manner.

Furthermore, there is a problem where, despite the incident occurring, the relevant individuals conceal it or do not take action due to other reasons. In this choice, there is likely an influence of the ineffective and slow nature of investigations-prosecutions, as well as the potential time loss due to calling for statements-hearings.

All these and similar reasons can not only fail to prevent unwanted acts but can also lead to an increase in them.

As a result of these explanations, it can be said that one of the groups most exposed to violence among public or private professional groups is doctors or health professionals. Additionally, it is also possible to say that as violent acts increase, legal and administrative measures have also increased. Currently, it can be stated that the most protected and guaranteed professional group in terms of legislation is health professionals. It would be beneficial to consider that a faster and more effective implementation may be possible, especially if the specified issues are taken into account in the notifications, complaints, and investigations made.